Morgan Hutt, BS1, Neelam Shah2, Nimesh Khatri, MD1; 1Medstar Shah Medical Group, Waldorf, MD; 2MedStar Shah Medical Group, Charlotte Hall, MD
Introduction: Suppurative appendicitis is a later stage of appendicitis which rarely presents as a colonic mass. The incidence of acute appendicitis as the presenting symptom of cecal and ascending colon neoplasms ranges from 3-15%. Asymptomatic appendicitis however presenting as a colonic mass is rare. We report a rare case of an asymptomatic patient presenting for colon cancer screening presenting with a cecal mass caused by suppurative appendicitis.
Methods: An asymptomatic 45-year-old African American man presented for screening colonoscopy. He had no history of abdominal pain or GI bleeding and had normal labs. His colonoscopy revealed a large, friable, approximately 4 cm cecal mass, endoscopically concerning for malignancy/advanced lesion. Biopsies revealed nonspecific inflammation, reactive changes, and lymphoid aggregates without dysplasia or malignancy. A CT scan revealed a heterogeneously enhancing cecal mass measuring 4.0 x 4.1 cm likely obstructing the appendiceal orifice and adjacent enlarged pericolonic lymph nodes measuring up to 1.8 cm. His CEA level was within normal limits at 1.3. Based on the endoscopic and imaging findings, the patient underwent colorectal surgical consultation and subsequent laparoscopic partial right colectomy with anastomosis due to concern for potential malignancy. Intraoperative findings revealed a bulky cecal mass with desmoplastic reaction/infiltration into the right lower quadrant and retroperitoneum. The pathology of the resection revealed a 7.5 x 5.5 x 3.8 cm area of acute perforated suppurative appendicitis associated with peri-appendiceal abscess formation, focal peritonitis, calcified fecal lithiasis, and reactive mucosal hyperplasia. No malignancy was identified. Discussion: Suppurative appendicitis is a later stage of appendicitis which forms when bacteria and inflammatory fluid which have accumulated in the lumen of the appendix cause obstruction of the lymphatic and venous drainage and typically leads to intense pain when the inflamed membrane rubs against the parietal peritoneum lining the abdominal cavity. Our patient’s asymptomatic presentation of suppurative appendicitis is quite rare as he had no abdominal pain and imaging did not suggest any evidence of appendicitis. Upon literature review, presentation as a cecal inflammatory mass as in this case is rare as well. Gastroenterologists should be aware of this rare, atypical presentation and consider this condition in their differential for atypical appearing cecal masses.
Disclosures: Morgan Hutt indicated no relevant financial relationships. Neelam Shah indicated no relevant financial relationships. Nimesh Khatri indicated no relevant financial relationships.